Risk Factors Of Postoperative Vertebral Compression Short-term Refractures After Percutaneous Vertebroplasty

Objective To investigate the risk factors of postoperative short-term new vertebral compression fractures after percutaneous vertebroplasty.Methods A total of 400 patients with vertebral compression fractures from January 2013 to December 2015 treated by percutaneous vertebroplasty were retrospectively analyzed.All patients underwent X-ray,CT,MRI,bone density and bone metabolism index examinations before surgery.Those who could not complete the MRI examination underwent ECT bone mass imaging.Patients were divided into refractures group(52 cases)and no refractures group(348 cases).The possible correlative factor included the patients'age,sex,vertebral height restoration rate,the Cobb restoration rate,number of basic vertebral fractures,fractures history,surgical approach,bone cement injection volume,leakage of bone cement and bone mineral density were analyzed by univariate analysis and logistic regression.Results All 400 cases were successfully operated.All patients were followed up for 6 to 24 months,average(15.6±3.8)months.Univariate and logistic regression analysis results showed that age,vertebral height restoration rate,and the Cobb restoration rate,fractures history,leakage of bone cement,bone mineral density were the risk factors for new vertebral compression fractures after percutaneous vertebroplasty(P<0.05 for all).There were no statistically significant differences in sex,number of basic vertebral fractures,surgical approach and bone cement injection volume between the two groups(P>0.05 for all).Logistic regression showed that the age(OR=1.08,95%Cl:1.04?-1.11),vertebral height restoration rate(OR=1.07,95%CI:11.03?1.12),the Cobb restoration rate(OR=0.93,95%Cl:0.88?0.98),fractures history(OR=2.37,95%Cl:1.23?4.56),leakage of bone cement(OR=2.29,95%Cl:1.20?4.34)were the risk factors of refractures,and the bone mineral density(OR=0.58,95%CI:0.35-0.95)was protective factors for refractures.Conclusion The reasons that may cause vertebral refractures after percutaneous vertebroplasty varied.This study show us that older age,excessive vertebral height restoration,excessive correction the Cobb restoration rate,a history of fractures,bone cement extravasation,low bone mineral density can significantly increase the incidence of new fractures.Regular anti-osteoporosis treatment during perioperative period can significantly reduce the incidence of post-operative re-fracture.To avoid new fractures after PVP/PKP.Doctors should grasp ite possible correlative factors,and need precise operation during the surgery.During the operation,bone cement leakage should be avoided.It is not necessary to emphasis on restoring the height of the vertebral body and correcting the local kyphosis Cobb angle.Patients should be guided to perform regular anti-osteoporosis drug therapy during the perioperative period.